Summary of findings 4. Ephedrine versus phenylephrine.
| Ephedrine versus phenylephrine for preventing hypotension during spinal anaesthesia for caesarean section | ||||||
| Patient or population: women having spinal anaesthesia for caesarean section Setting: hospital setting in Europe, North America, India, and the Middle East Intervention: ephedrine Comparison: phenylephrine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with phenylephrine | Risk with ephedrine | |||||
| Maternal hypotension requiring intervention | Study population | RR 0.92 (0.71 to 1.18) | 401 (8 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | — | |
| 465 per 1000 | 428 per 1000 (330 to 549) | |||||
| Maternal hypertension requiring intervention | Study population | RR 1.72 (0.71 to 4.16) | 118 (2 RCT) | ⊕⊕⊝⊝ Lowb,d | — | |
| 113 per 1000 | 194 per 1000 (80 to 470) | |||||
| Maternal bradycardia requiring intervention | Study population | RR 0.37 (0.21 to 0.64) | 304 (5 RCTs) | ⊕⊕⊝⊝ Lowb,c | — | |
| 243 per 1000 | 90 per 1000 (51 to 156) | |||||
| Maternal nausea and/or vomiting | Study population | RR 0.76 (0.39 to 1.49) | 204 (4 RCTs) | ⊕⊝⊝⊝ Very lowa,b,e | — | |
| 216 per 1000 | 164 per 1000 (84 to 321) | |||||
| Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 | Study population | RR 0.89 (0.07 to 12.00) | 175 (3 RCTs) | ⊕⊕⊝⊝ Lowb,f | — | |
| 11 per 1000 | 10 per 1000 (1 to 133) | |||||
| Neonatal Apgar score < 8 at 5 minutes | Study population | Not estimable | 321 (6 RCTs) | ⊕⊕⊝⊝ Lowb,c | No events observed in any studies. Relative effect could not be estimated. | |
| Not pooled | Not pooled | |||||
| Admission to neonatal intensive care unit | No studies reported this outcome. | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
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GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aSubstantial heterogeneity (−1). bInclusion criteria not representative of wide population (e.g. elective caesarean section only) (−1). cInadequate sample size (−1). dSample size inadequate and wide CI (−1). eWide CI (−1). fCI includes potential for ephedrine to cause either increased or decreased incidence of outcome compared to phenylephrine (−1).